Failure to Implement Non-Pharmacological Interventions and Accurate Monitoring for Psychotropic Medication Use
Penalty
Summary
Surveyors identified that the facility failed to prevent the use of unnecessary psychotropic medications and did not implement required non-pharmacological interventions for three residents. For one resident, aripiprazole and trazodone were administered daily for bipolar disorder and depression, respectively, but there was no documented evidence that non-pharmacological interventions were attempted as required by facility policy. Additionally, the resident's orthostatic blood pressure monitoring, as ordered by the physician to monitor for medication side effects, was not accurately completed or documented in the Medication Administration Record (MAR). Another resident received risperidone for schizophrenia and lorazepam for anxiety, with frequent episodes of anxiety and psychotic behavior documented. The care plan included interventions such as tallying anxiety behaviors and approaching the resident calmly, but review of the MAR and progress notes showed no documentation that non-pharmacological interventions were implemented prior to administering these medications, except for one instance where distraction was used alongside medication. The care plan also required review of behaviors and alternate therapies, but this was not consistently documented. A third resident was prescribed escitalopram for depression, with daily monitoring of depressive symptoms ordered. Despite documentation of multiple episodes of depression, there was no evidence in the MAR or progress notes that non-pharmacological interventions were provided before administering the antidepressant. Interviews with nursing staff and the DON confirmed that non-pharmacological interventions were not routinely provided or documented for residents on psychotropic medications, contrary to facility policy and physician orders.